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NBME 21 Answers

Block/Question (48.1 difficulty score)
A 24-year-old woman with sickle cell disease ...
Serum parvovirus B19 IgM antibody test๐Ÿ”

Block/Question (58.5 difficulty score)
A 6-month-old girl is brought to the ...
GM2๐Ÿ”

Block/Question (60.1 difficulty score)
An investigator is studying the efficacy of ...
Flagellin๐Ÿ”

Block/Question (26.2 difficulty score)
A 67-year-old man comes to the emergency ...
Translation๐Ÿ”

Block/Question (49.2 difficulty score)
A 45-year-old woman is brought to the ...
Absorption atelectasis๐Ÿ”

Block/Question (60.4 difficulty score)
A normal-appearing 17-year-old girl has never ...
Androgen insensitivity syndrome๐Ÿ”

Block/Question (22.5 difficulty score)
A 30-year-old primigravid woman at 22 weeks' ...
Listeria monocytogenes ๐Ÿ”

Block/Question (26.5 difficulty score)
A 52-year-old woman is admitted to the ...
Speak with the two gynecologists to attempt to coordinate care๐Ÿ”

Block/Question (14.3 difficulty score)
A 53-year-old woman who underwent an ...
Breast: antagonist; Uterus: partial agonist๐Ÿ”

Block/Question (26.8 difficulty score)
A 34-year-old woman is brought to the ...
Primary metabolic acidosis with increased anion gap๐Ÿ”

Block/Question (36.9 difficulty score)
A 27-year-old primigravid woman at 34 weeks' ...
Schistocytes๐Ÿ”

Block/Question (41.9 difficulty score)
A 25-year-old nulligravid woman comes to the ...
Endometrial hyperplasia๐Ÿ”

Block/Question (38.8 difficulty score)
A 25-year-old man develops shortness of ...
Decreased alveolar Po2๐Ÿ”

Block/Question (19.1 difficulty score)
A 21-year-old man is brought to the emergency ...
Streptococcus pneumoniae๐Ÿ”

Block/Question (44.0 difficulty score)
A 35-year-old man comes to the physician ...
Increased vascular permeability๐Ÿ”

Block/Question (58.3 difficulty score)
A 43-year-old man comes to the physician for ...
Aortic๐Ÿ”

Block/Question (78.4 difficulty score)
A 7-year-old girl is brought to a clinic in a ...
Methionine๐Ÿ”

Block/Question (22.9 difficulty score)
A 61-year-old woman is brought to the ...
Donepezil๐Ÿ”

Block/Question (43.8 difficulty score)
A 22-year-old man has had frequent episodes ...
C1 esterase inhibitor (binds activated C1r, C1s)๐Ÿ”

Block/Question (28.5 difficulty score)
A 10-year-old girl develops fever, malaise, ...
Retrograde transport through nerves๐Ÿ”

Block/Question (24.4 difficulty score)
A 40-year-old man with type 2 diabetes ...
Stimulation of the peroxisome proliferator-activated receptor ฮณ๐Ÿ”

Block/Question (36.5 difficulty score)
A 36-year-old man with AIDS elects to ...
Chemokine๐Ÿ”

Block/Question (45.3 difficulty score)
A 59-year-old man comes to the physician ...
Foci of keratinization๐Ÿ”

Block/Question (57.9 difficulty score)
A 23-year-old man drinks alcohol heavily on a ...
Fatty change๐Ÿ”

Block/Question (44.8 difficulty score)
A 28-year-old man is brought to the emergency ...
Dissecting aneurysm๐Ÿ”

Block/Question (35.9 difficulty score)
A 62-year-old man who is a farmer comes to ...
Actinic keratosis๐Ÿ”

Block/Question (26.9 difficulty score)
A 60-year-old man is brought to the emergency ...
Urethral disruption๐Ÿ”

Block/Question (63.0 difficulty score)
A 47-year-old man is brought to the emergency ...
Mixed venous oxygen tension๐Ÿ”

Block/Question (15.5 difficulty score)
A 34-year-old man comes to the physician ...
Cluster headache๐Ÿ”

Block/Question (43.9 difficulty score)
A newborn has female external genitalia and a ...
Dihydrotestosterone๐Ÿ”

Block/Question (52.2 difficulty score)
A 30-year-old woman comes to the office for a ...
Linoleic acid๐Ÿ”

Block/Question (60.0 difficulty score)
A 50-year-old man has had progressive dyspnea ...
Usual interstitial pneumonitis๐Ÿ”

Block/Question (23.8 difficulty score)
A 30-year-old man comes to the physician ...
Varicella-zoster virus infection๐Ÿ”

Block/Question (57.2 difficulty score)
A 30-year-old man develops urinary ...
Pelvic nerves๐Ÿ”

Block/Question (31.5 difficulty score)
A 7-year-old boy is brought to the physician ...
Increased blood lead๐Ÿ”

Block/Question (60.1 difficulty score)
A 51-year-old woman comes to the physician ...
Area labeled 'B' (Parietal cell)๐Ÿ”

Block/Question (20.6 difficulty score)
A 35-year-old man with diabetic ketoacidosis ...
Serum potassium concentration๐Ÿ”

Block/Question (22.6 difficulty score)
A 47-year-old woman with aplastic anemia is ...
Amphotericin B๐Ÿ”

Block/Question (34.8 difficulty score)
A 33-year-old woman comes to the physician ...
Genital herpes๐Ÿ”

Block/Question (32.5 difficulty score)
A physician prescribes a recently marketed ...
Phase 4๐Ÿ”

Block/Question (30.1 difficulty score)
A 35-year-old woman comes to the physician ...
Uroporphyrinogen decarboxylase๐Ÿ”

Block/Question (39.0 difficulty score)
A 36-year-old woman undergoes a total ...
Hyperplasia๐Ÿ”

Block/Question (36.9 difficulty score)
A 52-year-old man is brought to the emergency ...
Histamine๐Ÿ”

Block/Question (17.8 difficulty score)
A test has been developed to screen for human ...
Predictive value of a positive test๐Ÿ”

Block/Question (43.4 difficulty score)
An 18-year-old man comes to the physician ...
Pyruvate kinase๐Ÿ”

Block/Question (29.2 difficulty score)
A 66-year-old man is brought to the emergency ...
Lipopolysaccharide stimulation of toll-like receptor๐Ÿ”

Block/Question (56.3 difficulty score)
A 26-year-old woman (III-2) comes to the ...
50% in females but near 0 in males๐Ÿ”

Block/Question (33.0 difficulty score)
A 44-year-old man is admitted to the hospital ...
Increasing cGMP๐Ÿ”

Block/Question (37.1 difficulty score)
An 80-year-old woman comes to the emergency ...
Hydrochlorothiazide๐Ÿ”

Block/Question (47.1 difficulty score)
A photograph is shown of a myelin-stained ...
Loss of sensation to vibration over both feet๐Ÿ”

Block/Question (16.6 difficulty score)
A 27-year-old man comes to the physician for ...
Schizoid๐Ÿ”

Block/Question (40.6 difficulty score)
A 4-year-old girl is conscious but unable to ...
Pseudocholinesterase deficiency๐Ÿ”

Block/Question (52.5 difficulty score)
A 17-year-old boy returns to the locker room ...
Apocrine๐Ÿ”

Block/Question (30.6 difficulty score)
An 18-year-old woman comes to the office ...
Extensor carpi radialis brevis๐Ÿ”

Block/Question (71.3 difficulty score)
A 2-week-old male newborn has a patent ductus ...
Higher than normal left ventricular cardiac output๐Ÿ”

Block/Question (55.4 difficulty score)
A 38-year-old woman comes to the physician ...
Serum calcium concentration๐Ÿ”

Block/Question (31.0 difficulty score)
A 50-year-old man with rheumatoid arthritis ...
Anemia of chronic disease๐Ÿ”

Block/Question (53.9 difficulty score)
A 55-year-old man is diagnosed with renal ...
Cortex๐Ÿ”

Block/Question (28.1 difficulty score)
A 40-year-old man is brought to the emergency ...
Metabolic acidosis and respiratory acidosis๐Ÿ”

Block/Question (30.8 difficulty score)
A 42-year-old woman comes to the physician ...
Rosacea๐Ÿ”

Block/Question (36.2 difficulty score)
A 22-year-old woman, gravida 1, para 1, is ...
Internal iliac๐Ÿ”

Block/Question (69.8 difficulty score)
A 66-year-old woman comes to the physician ...
Diverticulitis๐Ÿ”

Block/Question (41.3 difficulty score)
A 53-year-old woman with gastroesophageal ...
Omeprazole๐Ÿ”

Block/Question (78.4 difficulty score)
A 30-year-old woman comes to the office ...
Abnormal brain development๐Ÿ”

Block/Question (60.0 difficulty score)
A 48-year-old man is brought to the emergency ...
Splenic and left renal๐Ÿ”

Block/Question (54.4 difficulty score)
A 34-year-old woman comes to the physician ...
Atrioventricular bundle๐Ÿ”

Block/Question (29.1 difficulty score)
Scientists have identified the flawed gene ...
Mismatch repair๐Ÿ”


Block/Question (44.0 difficulty score)
A 3-year-old boy who recently immigrated to ...
Increased proportions of osteoid๐Ÿ”

Block/Question (48.1 difficulty score)
A 14-year-old girl is brought to the ...
Trichotillomania๐Ÿ”

Block/Question (54.5 difficulty score)
A 35-year-old woman undergoes flexible ...
Superior to the superior concha๐Ÿ”

Block/Question (36.0 difficulty score)
A 33-year-old woman, gravida 4, para 4, is ...
Transfusion-related acute lung injury๐Ÿ”

Block/Question (31.3 difficulty score)
A 4-year-old boy with chronic granulomatous ...
Macrophages producing interleukin-1 (IL-1)๐Ÿ”

Block/Question (61.2 difficulty score)
A 65-year-old man dies in a motor vehicle ...
Squamous cell carcinoma๐Ÿ”

Block/Question (20.5 difficulty score)
A 54-year-old man comes to the physician for ...
Area labeled 'F' (Efferent arteriole)๐Ÿ”

Block/Question (43.8 difficulty score)
A healthy 32-year-old woman at 35 weeks' ...
Birth canal reflex๐Ÿ”

Block/Question (14.3 difficulty score)
A 47-year-old woman with psoriasis comes to ...
โ€œMost people find it difficult to stick to a routine. How did you do?โ€๐Ÿ”

Block/Question (15.8 difficulty score)
A 64-year-old woman with type 2 diabetes ...
Gemfibrozil๐Ÿ”

Block/Question (63.3 difficulty score)
A healthy 25-year-old man is participating in ...
Alanine๐Ÿ”


Block/Question (54.3 difficulty score)
A 37-year-old man is brought to the emergency ...
Intercostal๐Ÿ”

Block/Question (22.8 difficulty score)
A 17-year-old boy has the acute onset of ...
Lymphocytes๐Ÿ”

Block/Question (58.5 difficulty score)
A 68-year-old man comes to the physician ...
Libido: normal; Nocturnal erections: normal๐Ÿ”

Block/Question (49.2 difficulty score)
A 28-year-old man is brought to the emergency ...
Inferior rectus and inferior oblique๐Ÿ”

Block/Question (67.1 difficulty score)
A 4-month-old female infant is brought to the ...
Hyponatremia๐Ÿ”

Block/Question (17.0 difficulty score)
An investigator is conducting a study of ...
Enfuvirtide๐Ÿ”

Block/Question (28.4 difficulty score)
A 17-year-old boy is evaluated for ...
Craniopharyngioma๐Ÿ”

Block/Question (14.7 difficulty score)
A 63-year-old man with bladder cancer starts ...
Tubulin polymerization stabilization๐Ÿ”

Block/Question (48.3 difficulty score)
A 64-year-old man with bronchospastic ...
Enhanced action of the agonist at ฮฒ-adrenergic receptors๐Ÿ”

Block/Question (31.5 difficulty score)
Acetaminophen and nonsteroidal ...
Prostaglandin E2๐Ÿ”

Block/Question (31.3 difficulty score)
A 75-year-old woman has the sudden onset of ...
Posterior inferior cerebellar๐Ÿ”

Block/Question (19.4 difficulty score)
A 26-year-old man with HIV infection comes to ...
Penicillin๐Ÿ”

Block/Question (35.5 difficulty score)
A 78-year-old woman is brought to the ...
Embolectomy๐Ÿ”

Block/Question (25.7 difficulty score)
A 75-year-old man has the sudden onset of ...
Parietal lobe, left๐Ÿ”

Block/Question (33.3 difficulty score)
A 3-year-old boy is brought to the emergency ...
Synthesis of factor X (Stuart factor)๐Ÿ”

Block/Question (36.6 difficulty score)
An 8-year-old girl is brought to the ...
โ€œYour daughterโ€™s development is normal.โ€๐Ÿ”

Block/Question (41.8 difficulty score)
A 55-year-old woman comes to the physician ...
Increased parathyroid hormone๐Ÿ”

Block/Question (37.9 difficulty score)
A 75-year-old man has fever, back pain, and ...
Enterococcus faecalis๐Ÿ”

Block/Question (25.3 difficulty score)
A 6-year-old girl is brought to the physician ...
Poxvirus๐Ÿ”

Block/Question (51.2 difficulty score)
A 65-year-old woman comes to the emergency ...
Lung and common carotid artery๐Ÿ”

Block/Question (16.0 difficulty score)
A 30-year-old woman develops dimness of vision
Ethambutol๐Ÿ”

Block/Question (35.0 difficulty score)
A 40-year-old man with interstitial pulmonary ...
Increased radial traction on airways๐Ÿ”

Block/Question (14.9 difficulty score)
A 55-year-old African American man with ...
Tell the patient that he can change his mind about participating๐Ÿ”

Block/Question (45.3 difficulty score)
A clinical trial is conducted to compare the ...
Surgical procedure group: 400; Medical management group: 400๐Ÿ”

Block/Question (45.3 difficulty score)
A 70-year-old woman is found to have ...
Candida albicans ๐Ÿ”

Block/Question (37.2 difficulty score)
A 40-year-old African American woman comes to ...
1,25-Dihydroxycholecalciferol๐Ÿ”

Block/Question (50.5 difficulty score)
A 65-year-old man comes to the physician ...
DNA fragmentation๐Ÿ”

Block/Question (44.7 difficulty score)
A 55-year-old woman is brought to the ...
Mammillary bodies๐Ÿ”

Block/Question (35.5 difficulty score)
A 75-year-old woman is brought to the ...
Shrunken eosinophilic (red) neurons๐Ÿ”

Block/Question (22.3 difficulty score)
A 30-year-old man has had intermittent severe ...
Cysteine๐Ÿ”

Block/Question (65.0 difficulty score)
A 50-year-old man is found dead in bed at ...
Arrhythmia๐Ÿ”

Block/Question (41.8 difficulty score)
A 55-year-old man with hypertension comes to ...
Left renal artery atherosclerosis๐Ÿ”

Block/Question (35.5 difficulty score)
A 40-year-old woman comes to the physician ...
Antagonizes VLDL-cholesterol secretion๐Ÿ”

Block/Question (18.8 difficulty score)
A 35-year-old man is brought to the emergency ...
Activation of adenylyl cyclase๐Ÿ”

bilirubin
Block/Question (43.3 difficulty score)
A 47-year-old man has jaundice. Laboratory ...
Obstruction of the bile duct๐Ÿ”

Block/Question (60.6 difficulty score)
A 16-year-old boy is brought to the physician ...
Exercise-induced asthma๐Ÿ”

Block/Question (39.2 difficulty score)
A 66-year-old woman with pancreatic cancer ...
Short gastric๐Ÿ”

Block/Question (33.9 difficulty score)
An 83-year-old man comes to the physician ...
Bullous pemphigoid antigen๐Ÿ”

Block/Question (43.1 difficulty score)
A 25-year-old woman develops increasing ...
Four-chamber dilation๐Ÿ”

Block/Question (51.0 difficulty score)
A 68-year-old woman has had a fever and ...
Reactive granulocytosis๐Ÿ”

Block/Question (48.2 difficulty score)
A screening program is instituted for ...
10%๐Ÿ”

Block/Question (36.5 difficulty score)
A 9-year-old boy has mild mental retardation ...
Rhabdomyoma๐Ÿ”

Block/Question (37.8 difficulty score)
A 43-year-old woman dies after a 10-year ...
Area labeled โ€˜Cโ€™ (Caudate nucleus)๐Ÿ”

Block/Question (49.8 difficulty score)
Diastolic blood pressures are obtained in two ...
Median of group Y: higher; Mode of group Y: higher๐Ÿ”

Block/Question (44.9 difficulty score)
A 32-year-old woman comes to the physician ...
Dysplastic nevi๐Ÿ”

Block/Question (43.3 difficulty score)
A 19-year-old woman comes to the office ...
Descending colon๐Ÿ”

Block/Question (39.1 difficulty score)
A 55-year-old woman with a benign nodule in ...
External carotid๐Ÿ”

Block/Question (69.1 difficulty score)
A 1-year-old girl is admitted to the hospital ...
Disruption of the secondary structure of collagen molecules๐Ÿ”


Block/Question (45.1 difficulty score)
A 41-year-old man comes to the physician ...
Abduction of the upper extremity๐Ÿ”

Block/Question (48.2 difficulty score)
A 28-year-old woman at 18 weeks' gestation ...
Free T4๐Ÿ”

Block/Question (24.0 difficulty score)
A 72-year-old man comes to the physician ...
Bleomycin๐Ÿ”

Block/Question (58.3 difficulty score)
Left radial arterial and venous blood samples ...
HCO3โˆ’ transported in the plasma๐Ÿ”

Block/Question (39.1 difficulty score)
A 39-year-old woman with rheumatoid arthritis ...
Membranous glomerulonephritis๐Ÿ”

Block/Question (56.6 difficulty score)
A 63-year-old woman comes to the physician ...
Increased resting cardiac output๐Ÿ”

Block/Question (67.1 difficulty score)
Which of the following best explains why the ...
Myeloma cells do not have membrane-bound surface immunoglobulin๐Ÿ”

Block/Question (64.6 difficulty score)
A 5-year-old boy who has homocystinuria ...
The line on the graph labeled โ€˜Bโ€™๐Ÿ”

Block/Question (34.5 difficulty score)
A 28-year-old man develops a temperature of ...
Granulocyte colony-stimulating factor๐Ÿ”

Block/Question (26.5 difficulty score)
A 74-year-old woman with mild dementia is ...
Inability to understand the severity and prognosis of her medical condition๐Ÿ”

Block/Question (37.9 difficulty score)
A 65-year-old woman undergoes surgical repair ...
Area labeled โ€˜Aโ€™ (Cranial nerve 3)๐Ÿ”

Block/Question (35.9 difficulty score)
A 75-year-old woman comes to the physician's ...
Major depressive disorder๐Ÿ”

Block/Question (34.1 difficulty score)
A 27-year-old primigravid woman at 39 weeks' ...
Shoulder dystocia๐Ÿ”

Block/Question (20.8 difficulty score)
An undernourished 70-year-old man has fever, ...
Interferon-ฮณ๐Ÿ”

Block/Question (40.9 difficulty score)
A 23-year-old woman develops persistent ...
Stabilization of mast cell membranes๐Ÿ”

Block/Question (60.8 difficulty score)
A 28-year-old man comes to the physician for ...
Fructose๐Ÿ”

Block/Question (16.6 difficulty score)
A 38-year-old woman comes to the physician ...
Patent foramen ovale๐Ÿ”

Block/Question (25.6 difficulty score)
A 48-year-old man comes to the physician ...
Increased intestinal iron absorption๐Ÿ”

Block/Question (29.0 difficulty score)
A 29-year-old woman comes to the physician ...
Baclofen๐Ÿ”

cell_bio cell_transport cell_trafficking
Block/Question (52.0 difficulty score)
The gene that codes for a protein normally ...
Deletion of a hydrophobic amino acid sequence from the N terminus๐Ÿ”

Block/Question (58.1 difficulty score)
A 32-year-old woman comes to the emergency ...
Arthropod vector๐Ÿ”

Block/Question (45.6 difficulty score)
A 50-year-old woman has azotemia. Renal ...
Uterine cervix๐Ÿ”

Block/Question (43.7 difficulty score)
A 23-year-old woman comes to the student ...
Obliterative endarteritis with lymphocytes and plasma cells๐Ÿ”

Block/Question (23.9 difficulty score)
A study was performed that evaluated the ...
Odds ratio๐Ÿ”

Block/Question (61.7 difficulty score)
The FOXO transcription factor responds to ...
Nuclear/cytoplasmic shuttling: yes;
Serine phosphorylation: yes
Ubiquitin-mediated proteolysis: no
๐Ÿ”


Block/Question (50.9 difficulty score)
An 11-year-old boy has had persistent pain in ...
Lung๐Ÿ”

Block/Question (38.9 difficulty score)
A 55-year-old man comes to the physician ...
Cortisol๐Ÿ”

Block/Question (44.2 difficulty score)
A 14-year-old boy is brought to the physician ...
Inhaled glue๐Ÿ”

FA_missing
Block/Question (47.7 difficulty score)
A 70-year-old woman has had recurrent ...
Euthyroid sick syndrome๐Ÿ”

porphyria phototherapy
Block/Question (38.4 difficulty score)
A 60-year-old woman with psoriasis comes to ...
Porphyria cutanea tarda๐Ÿ”

renal SIADH hyponatremia
Block/Question (45.2 difficulty score)
A 64-year-old man is evaluated for cough, ...
Hyponatremia๐Ÿ”


Block/Question (35.7 difficulty score)
A 24-year-old man with a history of drug ...
Heroin๐Ÿ”

Block/Question (51.2 difficulty score)
A 4-month-old boy is diagnosed with a rare ...
Dilated rough endoplasmic reticulum๐Ÿ”

Block/Question (52.9 difficulty score)
A 25-year-old woman has a 3-week history of ...
Autoantibodies against platelet glycoproteins๐Ÿ”

Block/Question (55.9 difficulty score)
A 5-year-old boy is brought to the physician ...
Lack of choroidal pigment deposition in the macula๐Ÿ”

Block/Question (19.9 difficulty score)
A 40-year-old woman who had pneumonia due to ...
Surfactant๐Ÿ”

Block/Question (30.0 difficulty score)
A 48-year old man is referred for evaluation ...
Increase in width๐Ÿ”

Block/Question (12.0 difficulty score)
A previously healthy 4-week-old male newborn ...
Pyloric stenosis๐Ÿ”

Block/Question (34.3 difficulty score)
A 45-year-old woman comes to the emergency ...
Hepatopancreatic ampulla๐Ÿ”

Block/Question (56.6 difficulty score)
A 7-month-old boy is brought to the physician ...
46,XY๐Ÿ”

Block/Question (11.3 difficulty score)
A 47-year-old man is treated with colchicine ...
Tubulin polymerization๐Ÿ”

Block/Question (44.5 difficulty score)
A 57-year-old woman is brought to the ...
Ninth๐Ÿ”

Block/Question (58.7 difficulty score)
An investigator is studying the regulation of ...
Intravenous infusion of 0.9% saline for 5 minutes๐Ÿ”

Block/Question (35.0 difficulty score)
A 56-year-old man undergoes a renal ...
IgG plus complement๐Ÿ”

Block/Question (62.8 difficulty score)
An 80-year-old woman cannot concentrate her ...
2.0๐Ÿ”

Block/Question (25.0 difficulty score)
The immunosuppressive agent cyclosporin A ...
Interleukin-2 (IL-2) gene transcription๐Ÿ”


Block/Question (28.2 difficulty score)
A 56-year-old man undergoes surgical ...
Release of cholecystokinin๐Ÿ”

Block/Question (31.8 difficulty score)
A 22-year-old man comes to the physician ...
Formation of destructive free radicals๐Ÿ”

Block/Question (35.6 difficulty score)
A 5-year-old boy is admitted to the hospital ...
ApoC-II๐Ÿ”

Block/Question (33.1 difficulty score)
A 48-year-old woman comes to the physician ...
Paracrine stimulation of osteoclasts by osteoblasts๐Ÿ”

Block/Question (14.7 difficulty score)
A 19-year-old college student says he hears ...
Risperidone๐Ÿ”

Block/Question (49.3 difficulty score)
A female newborn delivered at 26 weeks' ...
Retina๐Ÿ”

Block/Question (47.5 difficulty score)
A healthy 8-year-old boy is brought to the ...
Stimulation of the release of biogenic amine neurotransmitters๐Ÿ”

Block/Question (25.1 difficulty score)
A 50-year-old woman is admitted to the ...
Didanosine (ddI)๐Ÿ”

Block/Question (55.8 difficulty score)
A 45-year-old man comes to the physician ...
Chondrosarcoma๐Ÿ”

Block/Question (46.1 difficulty score)
A 66-year-old right-handed woman develops the ...
Area labeled 'B' (Internal capsule)๐Ÿ”

Block/Question (31.0 difficulty score)
A 62-year-old woman is brought to the ...
Instruct the patient to keep notes and lists to help her memory๐Ÿ”

Block/Question (46.7 difficulty score)
A 46-year-old man comes to the physician ...
1/15๐Ÿ”

Block/Question (49.6 difficulty score)
A study is conducted to assess the normal ...
500 Men from a list of patients scheduled to be examined by a urologist๐Ÿ”

Block/Question (15.8 difficulty score)
A 66-year-old man with stage IV colon cancer ...
Loperamide๐Ÿ”

Block/Question (20.7 difficulty score)
A 20-year-old primigravid woman at 12 weeks' ...
Multifactorial๐Ÿ”

Block/Question (24.2 difficulty score)
A 4-year-old boy falls and lacerates his ...
Formation of fibrin clot๐Ÿ”

renal diuretics GFR
Block/Question (37.8 difficulty score)
A 28-year-old woman with chronic renal ...
Furosemide๐Ÿ”

neuro pharm magnesium
Block/Question (64.4 difficulty score)
During an experiment, an investigator ...
NMDA receptors are blocked by Mg2+ at the resting membrane potential๐Ÿ”

process_of_elimination Li_Fraumeni p53
Block/Question (44.3 difficulty score)
A 14-year-old girl is brought to the ...
TP53 ๐Ÿ”

Block/Question (23.3 difficulty score)
While lifting weights, a 24-year-old man ...
Strangulation๐Ÿ”

Block/Question (36.7 difficulty score)
A 75-year-old man with dementia, Alzheimer ...
Encourage the family to come to a consensus based on their perception of the patient's wishes๐Ÿ”

Block/Question (40.4 difficulty score)
A 76-year-old man comes to the physician ...
Left thalamus๐Ÿ”

Block/Question (19.6 difficulty score)
A 19-year-old woman is brought to the ...
Scaphoid๐Ÿ”

Recent comments ...

... nosancuck made a comment on nbme21/block1/q#5 (A 45-year-old woman is brought to the emergency...)
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urBh tle me etll yuo a lli cseert

EPPE prnestve tselitaAesc AAK atd UNGL LSCOLEPA

tnDo be inrywro ubato mrnoad rwsod hyet tpsu ni ntorf fo eht IHHG YEILD sone

hungrybox  literally LOL'd lmao I love this +13
... assoplasty made a comment on nbme21/block3/q#31 (A 28-year-old woman at 18 weeks' gestation has...)
 +64 
submitted by assoplasty(92)
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I nitkh the ntcpcoe thโ€™eyre igttens is het enaricdes GTB elsvle in ynacren,gp nad ton sutj erspoymtihrdhiy in l.engrea

nhWe rennsgcie ofr hity,moydpy/eihsrhopr TSH lvlees are AWYSLA prilfrneeaetyl ecckhed bceaeus hyet are mero eeiinvtss to mtnieu ifrneedecfs ni ./TT43 tneOf mtesi STH esvlel can atdtreeosnm a ghcean enve nehw TT/43 sevell era in eth aucsllbicni gearn. ehT onyl ieencoptx ot ihst uwodl be ni rynpecang dan( I sesug baemy lreiv fue?alir I butdo yteh odlwu ask this ot)hguh. hgHi gonstree lveles eespvrtn teh irlve romf angribke dwno GTB, nadlgie ot dnseciera TGB elvles ni hte eurs.m hisT nibsd ot rfee ,T4 inrgcdeeas the muaont fo evlbaaali efer 4.T As a cosraeypomtn nmceaihs,m SHT lseelv are insnyetrlat eandiscer and hte ERAT of 4T udipootcnr si sdnecriae to hnepseril anlisebe eerf 4T llesve. Hveowre eht ATTLO onumat fo 4T si asinrec.de

ehT sqeoiunt is niakgs owh ot infocmr myrdyptoeisihrh ni a pnegnatr manwo gt;--& yuo deen to hkcec REFE T4 elvsel bceas(ue eyht hsdluo be ramnlo deu ot tnpyremocsoa s)oeernp.s ouY natocn chekc TSH (yllusua ateevlde ni ygncprean ot snpaemotec rof icseeradn BTG,) and oyu otacnn check toalt 4T elsevl l(ilw be sn.aecr)ied uYo tog eth enrasw tihrg tieehr awy ubt I htkin sthi is a erffditen inenagros trwho cergnsind,io acbeseu hyte anc ska hits toenccp in trohe esotxtnc fo rt,eeg-hisspormeny dna if ehty iltesd โ€œHโ€ST as an rwenas ccheoi ahtt oudwl eb nirotce.cr

hungrybox  Extremely thorough answer holy shit thank u so much I hope you ACE Step 1 +7
arkmoses  great answer assoplasty, I remember goljan talking about this in his endo lecture (dudes a flippin legend holy shit) but it kinda flew over my head! thanks for the break down! +2
whoissaad  you mean total amount of T4 is "not changed"? 2nd para last sentence. +
ratadecalle  @whoissaad, in a normal pregnancy total T4 is increased, but the free T4 will be normal and rest of T4 bound to TBG. If patient is hyperthyroid, total T4 would still be increased but the free T4 would now be increased as well. +1
maxillarythirdmolar  To take it a step further, Goljan mentions that there are a myriad of things circulating in the body, often in a 1:2 ratio of free:bound, so in states like this you could acutally see disruption of this ratio as the body maintains its level of free hormone but further increases its level of bound hormone. Goljan also mentions that you'd see the opposite effect in the presence of steroids and nephrotic syndromes. So you could see decreased total T4 but normal free T4 because the bound amounts go down. +1
lovebug  Amazing answer! THX +
... lnsetick made a comment on nbme21/block2/q#3 (A 17-year-old boy returns to the locker room after...)
 +49 
submitted by lnsetick(90)
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  • ePinrcAo = your apitrsm lemsl liek an PAE
  • ecUMeRn = rโ€™htese no RMOO ni your eras scnei eeyrโ€™ht ulfl of axw
  • RYCEC-ne = henw uoy iesCerEc, ouyr epsro era CYngiR
  • osceBuSaE = muSBE si gPnESEi uot of uyor eposr
hungrybox  as an ape i'm offended +28
dr.xx  stop being an ape. evolutionize! +6
dbg  as a creationist i'm offended +11
maxillarythirdmolar  Also, Tarsal/Meibomian glands are found along the rims of the eyelid and produce meibum +
snripper  So why is it apocrine? The dude is EXERCISING when playing football. +2
qball  The question asks about "the characteristic odor" i.e. body odor coming from the APEocrine glands. The Eccrine glands secrete water and electrolytes. +1
... seagull made a comment on nbme21/block1/q#2 (A 6-month-old girl is brought to the physician...)
 +47 
submitted by seagull(1404)
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! I ahte teseh hiwt a igunrnb *inFg** .opsasni sumhTb pu if yuo ergea

mcl  Amen brother +1
praderwilli  Every morning: "I think i'll go over glycogen storage diseases, lysosomal storage diseases, and dyslipidemias after questions this afternoon." Every afternoon: Nah +28
mcl  oh my god are you me +1
praderwilli  I recently found a program called Pixorize. It's pretty much Sketchy for biochem. Wish I discovered it sooner cuz it has helped for a lot of the painful things like this! +6
burak  Cherry red spot basically means niemann-pick or tay sachs. Two differences between is: 1- No HSM in Tay Sachs, HSM in niemann-pick. 2- Both of them has muscle weakness but there is hyperreflexia in Tay Sachs, but areflexia in niemann pick disease. In stem cell HSM is not described and hyperreflexia noted. +4
abhishek021196  What is HSM? +
mysticsoul  HSM - HepatoSplenoMegaly. Cherry red spots think of Tay Sachs, deficient enzyme - HeXosaminidase A, accumulated substrate GM2 ganglioside. Niemann-Pick - Spingomyelinase, Spingomyelin <- which is not even a choice. FA18 Pg 88 +
lakshmi  Dirty USMLE has an incredible video that makes these super easy to get. +1
djeffs1  @lakshmi Link? +
... drdoom made a comment on nbme21/block3/q#49 (The gene that codes for a protein normally found in...)
 +46 
submitted by drdoom(806)
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hTe niyhetsss of lrlvaituy all rnpeiots A;ttidRmpg(-&e)epN usccro in teh .ctyospmla[]1 Tasโ€™th ewher lal eobosimrs iseer,d etafr a.ll oiRebos,sm hciwh are tsoylm ujst RrNA 2~(3/ ARNr + /13 e,iprnot* yb w,thi)ge era bssaedlem in eth ecnuuls ubt olyn od ethri utsff ceon ythe get to eht mcy.oaptsl

Fro a eontrpi to vaeel tsi griliona twoohmne fo hte oyolcts dan oecmbe a destrine of hte nsulceu o,r sy,yyyyya hte smicnaodelp i,ueuclrmt it seend to heav a etillt ntrgsi fo aionm acsid wcihh outsh Iโ€œ begoln ni het culseโ€n!u or Iโ€œ ngoble ni het mdicoslpane lucmuโ€tie!r

Ponierst yletlutiam dnesidet rof eth RE aconint na eaaiivnltinmugy daemn snrgti of iamon acids owknn as glโ€œsnai ,uqcenesโ€e c,hwih rfo het esoprspu fo hte Stpe 1, si sawlay ta eht e-r.nmuNtsi hTe anligs esecuqen llets ehrot sclticyoo tn,ierosp Heโ€œy! Teak em dn(a the rtse fo eth ideeppt fo icwhh I am tr)pa ot eth !โ€RE

nI eht aenesbc of iths lisna,g a oerintp liwl mriena in its adlutfโ€โ€œe mhoe of eth .osoclyt

suq&rso;reHe a icen ateismcch ghniwso the lwfo of opietrns mofr niitila ensisyhst ot nlafi edsintnia:sot


dnsetEon

  1. โ€œTeh shissetyn fo uyrtialvl all rnsetipo in teh llce ngseib no seiomrbos ni the olโ€.ocsty (sanietlEs lCel yloBgoi, Arlbtse et ,la. 142,0 .p 2)49

f*I you larely want yuro imnd no,blw rcisedon taht veen teh nertpoi tunisubs ttha mkae up atht 31/ of a eomboisr are teemlshevs itaiillyn eiehzsydsnt ni the ocl;yost lt,ear yteh ear dnatpsrotre ackb nito eth sucenlu iav het ucranle .epor

qball  Awesome explanation. Now explain it to me like I'm 5. +8
drdoom  All baby peptides are born in the cytosol. But some baby peptides have a birthmark at their N-terminus. The birthmark tells a special mailman that this baby needs to be delivered somewhere else. If you chop off the birthmark โ€” or erase it somehow โ€” the mailman never knows to take baby to its true home. The end. Now go to sleep or Santa wonโ€™t bring your presents. +36
... niboonsh made a comment on nbme21/block4/q#45 (During an experiment, an investigator observes that...)
 +45 
submitted by niboonsh(336)
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/=t4awHbouvzow/tuwet?2h/wcscDtp:yhmvu..wQ-o if ru azyl iekl em, isht si a gdoo eeefshrrr vdeio

d_holles  Amazing video dude. Somehow never learned this in neuro lol. +6
aag  Awesome video! Is this why you can give Mg2+ to eclampsia patients, because if so, mind goddamn blown. +1
... hayayah made a comment on nbme21/block3/q#33 (Left radial arterial and venous blood samples are...)
 +40 
submitted by hayayah(1056)
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the tjaormyi fo cbnroa iiddoxe elecslmuo rae iracdre sa rtpa fo the tiebacoanbr burfef y.tsems In siht tse,mys ncabro oexidid ufsesdfi tion hte .CBRs rcoabiCn aardhneys C)A( nwtihi RCsB kqyiucl octsnevr teh bcaonr oiedxdi noti bicarcon cadi C(H).O23 cbConira dcai is na bsanletu ermatdneeiit elmcuelo ahtt eeimtadylmi iceisotasds tion abaerbniotc ions C)-3(HO nda ydrhgeon ()+H s.ino

hTe leywn dynieestshz binoetbraca oin is tapnrotsder out fo the CBR itno eht lmspaa in ehncxage orf a hcrliode oni C(โˆ’;l) ihts is laclde the hcliorde hfit.s henW eht bdloo saecehr eth s,gnlu teh cobraitanbe nio si snaretptrdo bkac ntoi the BCR ni acehgnxe ofr the redhilco .ino hTe H+ nio icissedotsa fmor teh mobhinegol and dsnib to het rcibtnaabeo oi.n Thsi usodrecp het cbircnoa acdi ,mtieatdreeni ihwch is oeevtndcr kbac iton rcnoab dixeodi hgoutrh teh tceamyizn noacti of .AC eTh bornac didoixe cdedupor si eepedlxl rhhtogu eht lngsu dugrni .nxhtaoleia

hungrybox  Amazing explanation. Thank you!! +1
namira  in case anyone wants to visualize things... https://o.quizlet.com/V6hf-2fgWeaWYu1u23fryQ.png +5
ergogenic22  CO2 is carried in the blood is bound to hemoglobin, known as carbaminohemoglobin (HbCO2) (5%), dissolved CO2 (5%), bicarb is 90% +3
pg32  Nice explanation, but can anyone clarify how we know from the question that we are measuring HCO3 rather than dissolved CO2? +3
qball  @pg32 This question is asking about what accounts for the LARGER amount of co2 and the HCO3 buffer is about 85% of this transport and dissolved C02 is about 5-7%. https://courses.lumenlearning.com/wm-biology2/chapter/transport-of-carbon-dioxide-in-the-blood/ +3
teepot123  fa 19 pg 656 +1
... mcl made a comment on nbme21/block1/q#16 (A 43-year-old man comes to the physician for a...)
 +35 
submitted by mcl(579)
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dbeleaL RCX shgnwio ointpois of idefnrfte aesvv.l

hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +
hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +
mannywillsee  So the way to differentiate Aortic valve from the others is by checking the lateral view, AV will be more medial than both tricuspid and mitral; tricuspid will be more anterior and mitral will be posterior while Pulmonary is doing its own thing +2
... notadoctor made a comment on nbme21/block1/q#32 (A 50-year-old man has had progressive dyspnea on...)
 +30 
submitted by notadoctor(151)
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suUal etlrittanisi nomuespinit is teh ooahlcliigts odtfeinini fo idapiohItc amnryolpu iirs.ofsb eW ownk thta thsi pitenat sha lpnumyoar fsboirsi eaebucs het oisenuqt aestts tath eerht si oifsrbu icitengnkh fo eth rlavolae aptse. hisT ensiouqt asw jsut ntietgs ahtt ew wnke the ohert esnma for anuryomPl isoFs.irb

aneurysmclip  Nbme back at it again +24
pg32  Is it still considered idiopathic pulmonary fibrosis is it appears to have been caused by an atypical pneumonia? +1
zevvyt  Why not Sarcoidosis? Wouldn't Sarcodosis also be a chronic inflamation with fibrous thickening? +2
swagcabana  UIP is a better answer. Sarcoid is a leap in logic, usual interstitial pneumonitis is textbook histological definition of idiopathic pulmonary fibrosis. The biopsy has no mention of noncaseating granulomas and the clinical picture is not consistent with an inflammatory process. You have to focus on the better answers, try not to get caught up in the "why nots?" Calling this sarcoidosis is like someone coming in with prototypical asthma and jumping to eosinophilic granulomatous with polyangiitis. Sure its a possibility but its definitely not likely. +6
mangotango  I picked โ€œdiffuse alveolar damageโ€ with Pulmonary Fibrosis in mind but these are actually key words for ARDS :/ +1
zevvyt  thank you swagcabana! Very good explanation and strategy! +
... hungrybox made a comment on nbme21/block3/q#15 (A 47-year-old man has jaundice. Laboratory findings...)
 +30 
submitted by hungrybox(968)
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why lyoeihsms si ngo:wr

ehTer ldhsuo alsmto enrve eb thirgsta up ibibnliur ni eht uein.r nI sloymsie,h het xceess bliirbiun is dxectere ni hte bli.e Afert ablatierc osnroeincv dna ,eetarkup seom will be rcdetxee ni het ruine as liibor.un rweeH,ov ni ttbriseovcu d,osdrirse teh ucdnogteaj iuinbribl will vrnee vaeh teh puiptyntoro to nruodeg leabcatir cnosvnieor to ibinc/slr.uorteo In iths awy, hte oedjuacntg iuinbibrl sah no eohtr yaw to eb edcxtree ohert tanh lecdryit in het iru.ne

drciets ot a3a//arcu6n7l on derdit

skip_lesions  Found a good pic showing bilirubin metabolism +
... hungrybox made a comment on nbme21/block2/q#17 (Scientists have identified the flawed gene that...)
 +29 
submitted by hungrybox(968)
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hwne idff gneisl ransdt iarrep ichmseanms are :usde

  • paierr yenlw tzheeydnsis rn:dats tmcasmih erpiar h(ncLy y)odmerns
  • reipar irdympenii rsidem uadecs by dta UV seox:reup dlinecoteu nxicoise rireap ordar(eXem umtgineospm)
  • priera couopneaxssnt/ito :nialrtetoa bsea nosiecix rrpeia
meningitis  Brca: recombinant repair +
brotherimodu  P.40 FA2019 lists the different DNA repair mechanisms +2
teepot123  fa '19 pg 382/3 +
... jambo2222 made a comment on nbme21/block4/q#5 (An 11-year-old boy has had persistent pain in his...)
 +28 
submitted by jambo2222(28)
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tIโ€™s an o.rcaseaootms maScaro = mgatesoounhe .tems stโ€™I in het slge os tnkhi hwo a DVT oges to u.nlg aSme iae.d

tinydoc  Perfect way to remember it. Thank you! +7
chandlerbas  Iused the mnemonic PB (lead) KeTtLe....looking at the stem it said "osteolytic mass" meaning that it has to be either Breast, Kidney, thyroid or lungs. none of the rest are options leaving lungs. but jambo2222 very noiice that works too! +1
jajajaja  @chandlerbas I think you might be using the mneumonic backwards- PB-KTL is for primary cancers that met to bone. For example, a primary lung cancer can met to bone and cause an osteolytic lesion. But in this case the primary cancer is the osteosarcoma. Meaning that the mneumonic doesn't actually apply to this question +13
chandlerbas  ya you're right good stuff!! I dont know why that made sense during the question...anyways to add to the other comments...osteosarcomas are aggressive and 10% metastasize to the lungs via hematogenously at the time of diagnosis. +
mtkilimanjaro  just to add, in terms of venous circulation everything goes to heart via vena cava and then to the lungs. The only way the bone would metastasize to these other structures would be if it continued through arterial circulation without seeding, which seems unlikely. The only ones that spread to the liver are from the PORTAL venous system, aka not bone only colon etc. +1
... hungrybox made a comment on nbme21/block1/q#49 (An 80-year-old woman comes to the emergency...)
 +27 
submitted by hungrybox(968)
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zreordholthcoyiadHi is a diheizta rdiieuct tg;&= ieadizth csriuedti era stciseaaod twih .poakeihayml

thaW eohtr iriecsudt rae oatdiaessc thiw kamoiahe?ply ooLp cridutise.

W?yh

otibnhniiI fo N+a rioetnsorbap soucrc ni btho oplo teduciisr itb(nihi CKCN rrnpotcaeotr)s and iziatedh diurecist nith(iib aCNl rarptoecno).rsrt All fo iths ciernsead aN+ rcsesiaen teAerdnolso iytvtica.

lenRveta to tish lreo,mbp otAedensrlo auesrpteglu snopesxeri fo hte a+/K+N TAP tnarrteiop srarobeb( N+a noti odyb, lepex K+ otni n.u)lem hisT resltus in lhkepimyaoa in the .ybod

agnH on, tes'rhe orem ghih ylied i!onf

trenleAsdoo edso oen terho tmaopirnt nhtgi - ctaaintivo of a +H elannch ahtt slpexe +H tion eht eu.lnm

oS, ienvg ahtt sith paintet ash pmheaoal,iyk yuo wokn eehrt is euoitrpgulan fo edrAt.lenoso oD uoy khnti ehr Hp owlud be hhgi, ro ?wlo taxEycl, it ldwou eb hgih eeabcus .nic senlAdtoroe t=;g& i.cn H+ exepldel tnio het numel g&t;= ceaotlbim aks.asoli

owN uyo enaddturns hyw boht oolp uetdsrcii dan ithidzae ticrdiues nac caesu 'whtsa lledac o"payklehcim ctoiealmb "olaisl.sak

hungrybox  jesus this answer was probably too long i'm sorry +7
meningitis  I disagree. It's the complete thought process needed for many Thiazide/Loop question that can be thrown. Thanks. +12
amirmullick3  This is what NBME should be providing with each question's correct answer! Thanks hungrybox! +
amirmullick3  @hungrybox did you mean "All of this DECREASED Na increases aldosterone activity."? +1
pg32  Anyone care to explain why she feels she has, "lost [her] pep"? Is that due to the hypokalemia? Or hypercalcemia caused by the thiazides? +
cmun777  @madojo @pg32 I assumed between her hypokalemia (which can cause weakness/fatigue) and possible contraction alkalosis those were the most likely causes for the "lost her pep" comment. I think if they wanted to indicate hypercalcemia to differentiate if loop diuretics were also in the answer choices they would certainly give more context for hypercalcemia sx +
... acanthosisnegrocans made a comment on nbme21/block2/q#40 (Acetaminophen and nonsteroidal antiinflammatory...)
 +26 
submitted by acanthosisnegrocans(26)
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nI teh atreg sowrd of Dr tSaart:

it"nrlosganadP 2E estmieda refe"eeeeveeeee

IDNsAS -gt-&; bckol tngpidanlaors ysn

thisisfine   This is all I heard in my head +7
temmy  Me it was so weird +
peridot  I do want to add, that while PGE2 is the right answer, FA19 p.213 says that IL-1 and TNF are involved as well. However, because the question asks about what is going on in the hypothalamus, the answer is PGE2. If the question had been asking about what the macrophages were releasing to influence the hypothalamus, then the answer would have been IL-1 or TNF (FA didn't specify if it was TNF-a though...). +1
feeeeeever  You know why I'm here +5
... madojo made a comment on nbme21/block1/q#39 (A 33-year-old woman comes to the physician because...)
 +24 
submitted by madojo(160)

Know your STD's baby ;-) (going through every other choice on this question):

  • Bacterial vaginosis caused by gardnerella vaginallis. Se a thin, off white discharge and fishy smell (fish in the garden). There's no inflammation Lab findings: pH greater than 4.5 (just like trichomoniasis), and a positive whiff test with KOH. Stem will say something about malodorous discharge and show the infamous CLUE CELLS if we are lucky. Not the answer for this question obviously because we would not expect vesicles with this bacterial disease.

  • Candidiasis is going to be your thick cottage cheese discharge, with inflammation. normal pH see pseudohyphae. Treat with topical nystatin, or oral fluconazole unless you're pregnant than use Clotrimazole. Again not going to see any vesicles.

  • Chancroid per uworld is associated with Haemophilus ducreyi you will have a Deep purulent painful ulcer with suppurative lymphadenitis. Will be told that patient has painful inguinal nodes, there may be multiple deep ulcers with gray-yellow exudate. You do cry with H. duCRYi This wouldn't be true for what our patient has in this question because we aren't told of any inguinal adenopathy. a link to a chancroid VDA

  • Chlamydia trachomatis causes lymphogranuloma venereum which is small shallow ulcers, painless, but then the large painful coalesced inguinal lymph nodes aka BUBOES. Compared with gonnorhea the discharge is more thinner and watery. Again not the case here as its painful and no mention of any BUBOOESS. The discharge in gonorrhea is more thicker. Both lead to PID, treat for both because confection is common. With both patient may have some sort of pain or burning sensation upon urination. Sterile pyuria though for both.

  • Condyloma accuminatum is a manifestation of HPV 6 + 11 (genital warts). They look like big cauliflowers. This is in contrast to Condyloma lata that you see in syphillis which is just a flatter latte brown looking macule.

  • Genital Herpes (the answer to the question) will present with multiple painful superficial vesicles or ulcerations with constitutional symptoms (fever, malaise) Just fits better than all the other choices I ran through.

  • Syphillis is the painless chancre. UW describes it as a single, indurated well circumscribed ulcer, with a clean base. See corkscrew organisms on DF microscopy. Keep in mind other painless ulcers are lymphogranuloma venereum of clamydia (but the buboes are whats painful not the ulcer), and granuloma inguinale (donovanosis - klebsiella granulomatis) but whats hallmark about this one is that its painless without lymphadenopathy

In short, be safe.

drdoom  this write-up is AWESOME ... but it also made me vomit. +
b1ackcoffee  This is awesome, writeup, not the stds. +
lovebug  FA 2019 pg 184. I summed up @madojo's comment! this patient have "multiple, tender vesicles and ulcer". and scant vaginal discharge. A) Bacterial vaginosis -> NO vesicle -> r/o B) Candidiasis -> NO vesicle -> r/o C) Chancroid -> should have Inguinal Adenopathy -> r/o D) C. trachomatis -> have Large painful inguinal LN -> r/o E) Condyloma acuminata -> Big Cauliflower -> r/o F) Gental herpes -> YES!!! G) Gonorrhea -> NO Vesicle, creamy prulent discharge -> r/o H) C. trachomatis again (same as D) -> r/o I) Syphilis -> painless chancre -> r/o J) Trichomoniasis -> strawberry cervix, motile in wet prep -> r/o thanks @madojo! +
... sympathetikey made a comment on nbme21/block3/q#4 (A clinical trial is conducted to compare the...)
 +24 
submitted by sympathetikey(1252)
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โ€ข rPe olProoct - Olyn uicdeln nptseati ni eht selstru ohw owollefd the otopclro

โ€ข sA dtreaet - aDat s,ewi olny tetar eht sjsebutc sa teyh weer eadrtet xe( - if lipnmeaexrte eaitntp deos twah hte orlncot iaepnstt are pdsopeus to o,d oevm htta eaprtnemilxe attenip to eth lcoornt rupgo

โ€ข nneIitnot to ttare - lduecIn lal pesttani ni hte goprus ehyt rewe ilognilayr edmnoirzad to

... assoplasty made a comment on nbme21/block2/q#29 (A healthy 25-year-old man is participating in a...)
 +23 
submitted by assoplasty(92)
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Fsat era ineoekctg ecextp( dod acnih F)A, so they roepudc neesokt rof ygeenr onpotiurcd )cCyelA-(Aot arrthe nhta co.lsgue fI the tsioqnue eadsk what eht rmypria suocer fo yengre oupdoncirt aws, ti wodul iltsl eb gnlecogy d(na otn )nkseoet, bacsuee isht is iitwhn 42 hor.us ewvrHoe eafrt 42 rhuos the nreswa lcdou eb eonetk .ibesod Rasgdleesr, eht oqetsuin liliycscfpea dsai eht tp adh a esmru lugecso fo ,010 ndginiatic atth we aer lgnooik for tihgmseon hatt pvrosied a rsetbauts for lgsscgenenieuoo.

Drniug eisdrop of vti,aorsnta etssautrbs ofr gegsuinsloocnee omec mfro owt ruos:sce 1() ankbrwdeo fo igesitxn mue,lcs ro )2( iva -hcoiadnd AF hhoutrg pAi.lCy-ropoon *(lnaiVe aosl fsede tino iynorppol A,oC tub si otn novvlied dignru vrtainsaot -&g-t; ees wle)ob

)(1 hTe epvayatrn-uelain eccyl oidsvrpe hsit aimutnegl( in esmulc + ateyurvp g--t;& leniana -t&;g- gsoe ot ivlre &-gt-; rmisnnniaottaa to alerateok-otlgthpua ;g-&-t eavyuptr si apeardtes ofrm gmutnalei -t&-;g amintelgu seog to erau yc,cel ytpevuar goes on to gneog)enucosle.si taecatL acn olsa eb deus ths(i odlcu aveh nebe a hgrit reasnw if ti erew edlsi.)t

2)( ddO canhi AFs rea aols ngecilcu,og ubt isratec iadc v(iedprod in eht eawsnr ciehoc) sniโ€™t odd ich,an os ti is lnyo igktceone nda nca eb rdule to.u

lhAhtuog liavne da(n rheto ahdbrnce a.)a. fdee tnio inP,roA-Clooyp yeht are ont seud in ioatvratns basceue vrtansotia ttcylirs leresi on ihtcape neluoiegssngoe.c Thees .a.a aer ton aeodemzibtl in eht vrlie ebcesau the relvi ckasl ahicdarhn-bcne aa.. nseaafrestr n.eemyz In isFtr d,Ai Bhmeoci ecsni,to derun taFtnni/Ssoai,arvtg in ohbt the asโ€œntgif aestโ€t hih(cw is nwtiih hte temi rmefa fo shit u,qo)tenis ro the aโ€œtarsovnit tstโ€ea, othb eultizi chpaite oncelng.oeiegsus yM muaopsstin si ahtt evianl is eusd ridgun rreulag lometsiab,m dna otn duignr sdpireo of vtonsa.itra

hello  I want to re-emphasize something that @assoplasty has already stated :). The Q-stem states serum glucose = 100, and the Q asks why the patient is able to maintain normoglycemia. Therefore, you can immediately eliminate choices A and C because acetoacetate and beta-hydroxybutyrate are sources of energy during ketogenesis -- ketogenesis does not provide glucose energy sources. +7
chandlerbas  ^ this checks out: valine and isoleucine are broken down in the muscle into branched chain 2 oxo acid via branched chain aminotransferase (reversible) then the valine and isoleucine leave the muscle and swims to the liver to be acted on by branched chain 2 oxo acid DH (irreversible). So bascially the process from taking BCAA valine and isoleucine requires 2 enzymes. the first enzyme is in the muscle, and the second enzyme is in the liver (for simplification purposes --> both organs contain both enzymes but dont have the same affinity for their substrate). source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1147506/?page=4 so you're right to say that the liver +4
toxoplasmabartonella  Thank you for such a great explanation. Isn't it glutamate instead of glutamine that combines with pyruvate in muscle to yield alanine for Cahill cycle? +1
almondbreeze  @ toxoplasmabartonella think you are right +
... cantaloupe5 made a comment on nbme21/block1/q#3 (An investigator is studying the efficacy of distinct...)
 +22 
submitted by cantaloupe5(72)
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uClaaspr pcdheaoscilray ivcsecan ear etnof gneucoatdj ot srotpine to epmovir mnmiygonciteiu. nglFlliea is the nyol nrwase iechco hstt'a a petoi.rn

mambaforstep  both MHC 1 and 2 are present antigens that are PROTEINS (FA 2019 pg 100). so in order to elicit a T cell response, you need a protein (CANT BE A POLYSACC). that is why vaccines for polysaccaride antigens are often conjugated to PROTEINs--> so that we can elicit a T-cell response (FA 2019 pg 127). +5
lovebug  Flagellum = Protein, (FA19, pg.124) +
... usmleuser007 made a comment on nbme21/block1/q#17 (A 7-year-old girl is brought to a clinic in a...)
 +22 
submitted by usmleuser007(370)
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fI uyo lcodu'tn embermre ihchw wree nlai;teses nteh vrntaaeeitl ulowd eahv been ot ieaezrl ahtt irwnggo ihclerdn eden llcse ot vediid. Tshi qrsuiree DAN aplciroient nad oata.tirnsnl Of ichhw het cucneil adic yithem si nroat.impt tI qrrieues a ytemhl eranfrst.

Tish si ewhre mnhneieiot osmec .in hinieMnoet mincseob tihw APT to orfm MSA (a hmtlye donr)o

whossayin  Thatโ€™s a legendary explanation. Thanks dude! +
makinallkindzofgainz  This is exactly how I solved it! I remembered that Methionine is essential for methyl transfers, and you would need that in dividing (growing) cells. But now I'll just remember PVT TIM HaLL too :) +2
... flashvoyger made a comment on nbme21/block4/q#25 (An 80-year-old woman cannot concentrate her urine...)
 +22 
submitted by flashvoyger(22)
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ehT nsuoetqi si ianskg oyu ohw uchm rweta smut eht anomw atek in ot mniatian eth msea ooa.tiysmll Tsih awnom easkt ni 504 mmsO fo soulte rpe d.ay ishT si a unti fo eammrensute -- inkth of ti ilke .msrag

orF erh to eepk the seam iolyslaomt hse umts xercete 054 mmsO erp ay.d eTh oyln way for erh ot treexec eth uloste si vai hte yks.nied ehT oynl ayw rfo reh sdeiykn to ecxtere 504 smOm si if hyet eetxerc 1 elrti fo etwra sloa. hisT is teh xam nicntaotceorn tath ehr nydeiks anc .creuopd H(re enisdky era otn rlโ€œwofpue ehuโ€ngo to kmea rhe unire yna erom droacttnceen tnah )tth.a

Tihs nwoma is olas osinlg nreaoht rtiel fo wrtea ot efce,s snitawge nda tn.oreirpsai hsTi is teh siesenbilnโ€œ arwet ol.ssโ€ aTth names if hse liogsn 1 ielrt fo ertwa to ,wtesa ripitarnsoe nda cfees rep yda slpu 1 tlire fo tarwe to reuni aeuec(sb hes seden ot ssdliveo erh ueltos in higenom,ts)! orf her obdol ot tays eth aesm lsomoti,lya ehs sumt celearp the ratew seh tsol htus t,usm at mmun,mii rkidn 2 selitr fo wrate erp day.

jean_young2019  great explanation๏ผThank you๏ผ +
... taway made a comment on nbme21/block2/q#14 (A 30-year-old woman comes to the office because she...)
 +21 
submitted by taway(29)
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hsiT seuotnqi is edsahrp tsgraye,nl utb s'ti istylsaenle ksngia hwa"t uodwl eanphp fi iths nosawm' dihyooihrytmsp bmeace oulnoecrtdln eorv the uercos of hre aencnry?pg"

urnecytlr rhe SHT is doog &-;-gt dnwlllo-rtecelo AdomrhCETipshyLyOiHTHoYPt I hgih TSH g&--t; rhe imtpsdyroyhhoi tmsu NTO eb orletlocld-lenw due( to ouisntrdpi fo het 4STT3/R/THT/H doircnene xias)

o,S won thta ew rndsaedntu ttah het oqnetisu si isknag h"taw olwud pheanp fi ehr tdryishyoiophm wsa udec?nrlo"tnol

er:swnA irnitemcs

I kihnt taht htis qsnoitue is rdaphes rsoty,aioclu utb rfa eb it fmor me to zicrticei the SUELM nlnseciig .bo.rda.

yotsubato  I think that this question is phrased atrociously, Just like the rest of the NBME +17
b1ackcoffee  exactly how does maternal hashimoto can cause cretinism? +
notyasupreme  @b1ackcoffee, it's not maternal hashimoto, basically you just have to disregard the ENTIRE question stem and the last part of the sentence (if the mom's TSH goes up) means that there's hypothyroidism going on, which causes cretinism. +1
b1ackcoffee  Thanks you @notyasupreme! +
... g.liller@yahoo.com made a comment on nbme21/block3/q#5 (A 70-year-old woman is found to have persistent...)
 +21 
submitted by g.liller@yahoo.com(27)
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dinaaCd si a atpr fo the anolmr folra fo n,kis dculo asecu natniatcinmoo of a lreatcn enosuv trceeta.h Teh uentiqos tatess ttha eth sonmiagr si ,luprpe nd,gdibu idd not nodsper to obard tmepsruc cnstaitoiib kaa( yhet td'dni sue aocuofnzlel or prtahnmiieoc ).B stay,Ll yhte dsohew ti teldpa no dbool arag adn ereth was on lssiyemho ihhwc aetnliimes athsp t(he yoln ohrte lssebiop ernncteod .er)he

Coctospryccu ullyaus sevolniv gnteniimis ni dmiomermcmnoopsui .pts E. coli is ragm trnatsoerepovii hxg is lsuualy tsmtentidar yb a tnohr on a reos or semnooe thiw a rhstoyi of igaegndrn

hungrybox  Also, the yeast form of Candida is gram (+) +24
dr_jan_itor  I got thrown off by the part where they said "ovoid" and thought they were implying a cigar shape. I chose sporothrix for the morphology in spite of knowing that it clincally made no sense. +1
lilmonkey  I chose S. aureus before reading the question (looks like b-hemolysis). Then I saw "budding organisms" and picked the correct one. +
the_enigma28  I think, elliptical budding yeast forms kind of excluded cryptococcus since its almost round -_- +
the_enigma28  I think, elliptical budding yeast forms kind of excluded cryptococcus since its almost round -_- +
lowyield  cryptococcus also doesn't take up gram stain because the shell is too thiqq +2
... henoch280 made a comment on nbme21/block4/q#15 (A 5-year-old boy is brought to the physician for a...)
 +21 
submitted by henoch280(50)
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e@.tmym shiT oqistune tests rou owgkneeld no lnamisbi wcihh si lymlnrao a itoreyssan dyiecefnic adsiees utb eth eingtevt etasst that eht ys'bo asnbiiml si cdseua by a cietgen onumitat in the Y1PRT gnee hchwi si ohwns in hte mciceihblao hwaapty. A eneg htta plhes ni hte systenhsi fo .elinanuEm

woN ouy ehav to unartddsen tath all russporecr foereb tath eegn is eht waythap louwd lsitl be vlibealaa fi ton seaecnrdi hhwic ekam 2 of het sntpioo in hte tqsonieu .gwonr

you laso vaeh ot dunsrtdnae Ei a:ueti(lsnm)nh = ml(ieonnrno)am .ie roamln lanmnei cwihh is irceptvteo to het ks,ni rsedasece aiertvec exgyon eecpiss and vesig the kard tgipsmne ot hte ,iirs rohoc,di kis,n irha fe.(n..a lil hmoee)ientwc = il)e(nkafeanm .ei aelhimen,pon hte neo enpesrt ni uro aetptni erhe hchiw si less tpieorcetv agnai eht vu yas,r ctaonn pinmegt nda tncaon creeedsa ORS adgneerte ni het k niis. ohep htsi elhsp

... pparalpha made a comment on nbme21/block1/q#35 (A 7-year-old boy is brought to the physician by his...)
 +20 
submitted by pparalpha(83)
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edaL Toiiytcx :

easus:C rdusnpitoi fo ehem shtesinsy iva tinnboihii fo AAL aiuleanonmeti(lv hadeersty)da

snn:idgFi

A: Aaenim

B: Bcispiahlo plpngsiti

C: ilCoc

D: rehrDiaa

E: Ecaptlypneahoh

F: tooF rdop

G: Gum pswtged/tohsori roeuttgrina/atod

H: THN dan irmcueehpyear

hrOte raewsns:

nciZ cceeifnydi:

e:susaC olw i,antke hrnC'so sseaide

isdnng:Fi nemuim ouiy,dnntcsf aedpimir odunw nhgiael (rof het emldinoreg hasep of wnudo hani,leg nicz si endeed by sasieroolnletempat to raekb odnw etpy III oc)nl,lega shanoypd,iomg edrr,aaih atrti,deism ,licpaoea barmolna teats dan lmels

sEscxe is .rae..r utb nac dale to //nvd nad nmlbdaioa inap

nesMugmia cecfeinydi:

uaCss:e ige,nntcaol louyi,rpa aitlnm,tnioru etxaliva ubsae

nsinFdg:i t,neaty erpuaetrm lernrictuav icottc,arnno dcnriaese TQ vrntalie

2B1 fcediyiecn:

:euCssa enavg it,ed oiserucpin nea,ami riccptaean usei,ss scaitgr bsaspy r,ryesgu aonsoitalbrpm (rCh,on ,srep)u tDoporliybmulihh ewrmtpuloa/catm feoicnnti

dsiFn:ngi caoitcc,yrm tlciaoagmsble eaain,m neuro moysmps,t iesnecadr tniysoohmeec dna MMA lveles in umsre

secedrIan itaVinm D:

Ca:ssue nraoustoaulmg iasesde oscdiao)(sisr

nigs:nFdi enbo tr,irponseo oot umch icu,amlc sols of tepeapi,t ourtsp

lovebug  2019 FA, pg 411. +
lovebug  Nephrotoxicity results from lead exposure because the kidney is the main route by which lead is eliminated. Lead is absorbed by the proximal tubular cells of the renal tubules, where it binds to specific lead-binding proteins. +
... hungrybox made a comment on nbme21/block3/q#3 (A 55-year-old African American man with hypertension...)
 +20 
submitted by hungrybox(968)
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eTh 2 dnommcmaestn of sthcei nstqs:euoi

  1. onDt' erve pikc na swanre rhwee you udnos lkie a ckdi
  2. 'nDto reev lsncout eht ischet tectoemmi

drSeev em lwel no tish tqu.eosin

linwanrun1357  If there is a choice about asking what the patient is worried about. Is this right? It does not sound like a dick :) +1
champagnesupernova3  If this were about a treatment asking why hes worried would be right but hes kind of doing the hospital a favor so I dont think you're supposed to try to convince or pressure him +1
brasel  also, any patient participating in any research study can withdraw whenever they want. Answer E is wrong because he shouldn't have to go through hoops to quit, he can just drop out at any time. +1
... drdoom made a comment on nbme21/block3/q#21 (A screening program is instituted for detection of...)
 +20 
submitted by drdoom(806)
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,0052 seuttdsn ... utb ouy idnf out ndrgui yuor tnliiia srcnee htta 500 redyala eavh eht a.sdesei S,o ottkrisue hseot eolpep. Ttah leesva 00,20 stetndus woh โ€™ndto ehva het seea.sdi

verO het srueco of 1 rye,a uyo csveodri 002 tetsusdn evepoedld het e.iiftnocn uTsh:

200 wne scase / 0,020 pleope how dditnโ€™ heva teh sisaede newh you tseradt ryuo sytdu = 10 repcent

k,iyTcr tkryci EBMN ...

sympathetikey  Ah, I see. Thank you! +
niboonsh  Im mad at how simple this question actually is +7
sahusema  Incidence is measured from those AT RISK. People with the disease are not considered to be at risk. So 2500 - 500 = 2000 people at-risk. Of those 2000, within one year 200 develop the disease. So 200/2000 of the at-risk population develop the disease. 20/2000 = 10% = incidence +3
daddyusmle  fuck im retarded +2
... usmleuser007 made a comment on nbme21/block4/q#43 (A 4-year-old boy falls and lacerates his lower leg...)
 +20 
submitted by usmleuser007(370)
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  1. bo(oasHssodieย tml ligt)oc:tn htniWi eth tfris efw umesitn fo unyijr,
    1. ttย ipaenlles the dbool being ot tskci ot eht djueinr tsei.
    2. isTh icevatast hte e,stllapet iugnasc a wfe nisgth ot pphn.ae
    3. Tehy acegnh onit na opmursaoh ah,esp orme seailubt fro i,ntcotgl nda ythe alreees icmhecla lgassin to oropmte nttcg.oli
    4. ihsT usslret ni eht aniotcaitv ,fibifrย on cihhw msrof a smhe dan tcsa as u""gle to idnb tletepals ot aehc .hrtoe
    5. hsiT amkse aclhtatoย tย  vssere ot glup het rkaeb in het dlboo vsee,ls nnv/rpgloistiewnge hterfru 65d]n]geie.[b[l

  2. lonimatIfnm:a nDrigu isth es,hap ddmeaga dna ddea ecsll rae daecrle out, logna htwi teriaabc nad otehr pegosntah or irbe.sd
    1. sTih aespnhp ourtghh het scspero sogoyoย pc,tsafhi ehrew tiwhe olobd ellcs et"a" bisder by gnnfugeil ย t.i
    2. ea-iretPltddevel trgwho rscftoย aera alsdreee otni eht wnudo that csuea eht armiinotg and osividin fo sellc udgnir teh pirvaetlfiore esp.ha

  3. tolaenPiorirf hr(gtow fo wen )itse:su In hits l,naย lgt,ย neoiiuctapย gย nrdiesopesiehoggnnso,aealnsioa s,simย eonoiurtfta zlehnoipaita,eitli adn owudn tcnoocraint r.oucc
    1. nI soeng,inigsae avculars lhelaoendti lecsl ofrm enw odlbo s.veessl
    2. nI oiafpaisblr nda nntoalugair suteis frooorssaย abtnmbfirltย w,gio and mrof a ewn, iclvanurllrieoeoย parastxl )ย imE(axtCrM yb txreicgne ngoelcla onย fneicndrt.aib
    3. eCcuonl,nrtry ieiieilhpaatzo-ntelr of hte smederpii s,roucc ni iย hhilaheiwepltc flย eaptsileelrcor nda c'la'wr poat eht onwud ed,b rpvndiigo ecrov for eht ewn st.suei
    4. nI nuwdo srooisb,bteaanlteareyotcย dciย mcofnsr hte zise fo teh wdnuo yb pggpirin eht dwuno dsege nad itntgncarco isngu a shanmiecm ahtt eleesmbsr ttha in thomso ulmcse ell.cs
    5. enhW hte lelcs' lsoer rea oeslc ot eolmet,cp ueednned ecsll gย ntpoiaodspu.sero
  4. iuotMatnra (liee:d)ogrmn ungrDi taronumati dna ,rmlondiege

    1. nelogalc si dairgeeln lanog insntoe ,lensi and elslc atth rae no nelorg eeddne era vdomeer by mardeprgom clle atd,he oย os.iptaorsp

  5. rAaoexippmt emist of hte dritfnfee eashps of unowd 10gh]ita[iewlย nh, afedd litsvrane nigrakm stausalnitb oiv,nratia nngdieedp yminla no uwond siez dna ilhaneg ditsioco,nn but emaig soed otn lucneid oamjr timpmersain atht uahricnsย ocec odsnuw.
mumenrider4ever  Great explanation! FA 2020 pg. 216 describes the phases of wound healing +
... mcl made a comment on nbme21/block2/q#30 (A 44-year-old man comes to the physician because of...)
 +19 
submitted by mcl(579)
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iThs is a prteyt oogd fruige gwisnoh het oenovsinrc fo rememnab iposohsiplphd ot nrcicdhiaoa eutlaoi/nekceisrd .tec

dlaocBke fo CXO nemzye by fnuibepro tsleusr ni ascrddeee udcrtpinoo fo lpagnosintasdr 2H dna 2E, ilweh caiugns eth srpucserro ot bkac" "up ce(aesrndi driccanioha a.cd)i Ths,i ni ,tnru urlstes in ircnedaes roptdunoci fo tlneuries.keo

icedcoffeeislyfe  FA2020 pg 485 has a figure that is helpful! +1
... hayayah made a comment on nbme21/block2/q#50 (A 65-year-old woman comes to the emergency...)
 +19 
submitted by hayayah(1056)
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ehCrtate :elmtepanc

msadu2la/0ne0ejkspn84y0eoo6eo/g/tce/g0:nsp1h8-p.ami/ptt//.tw0c

caRlle htat teh lgun pxea dstexen eabvo hte tfisr .bir

hungrybox  His expression is so blissful. U can tell they're shootin up some full u-opioid agonist codeine type of shit and not some shitty partial u-opioid agonist buprenorphine type of shit or some shit like loperamide that doesn't even act on the CNS +29
rerdwins  even better, if you recall that the esophagus is RETROperitoneal ( its in like half the answer choices). hence, to get to it you have to go WAAYYYYY deep ( like rick and morty smuggling shit). after that, the lung option makes the most sense. +11
hello  Also, pulmonary artery is way too far away to be damaged by internal jugular vein catherization. +
makinallkindzofgainz  @hungrybox my mans just slipped in 3 high yield facts within a joke +3
makinallkindzofgainz  @hayayah, I have an issue with that picture unless I'm missing something. In every other source I have, the internal jugular vein lies LATERAL to the common carotid artery. The picture you provided shows the internal jugular veins medial to the common carotid artery. +1
cmun777  Look at the other side... I think it must be the manipulation of turning the head to the opposite side that better exposes the jugular for catheterization purposes +
... beeip made a comment on nbme21/block3/q#4 (A clinical trial is conducted to compare the...)
 +19 
submitted by beeip(123)
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I hmitg eb eth nloy oernps on haetr how ogt siht one ,rgonw utb :sarleedgsr

ITT" niysalsa esucildn ryeve ubesctj owh is zeidmnodar gcdarinco ot znddoaemri teatnrmte nnagis.tmse tI nsgoeri ,cmniooenpancl tporlcoo idtsnvaeio, ida,whtwlar adn inynathg thta easppnh trefa itoaoimar."nznd[]1

yo  You're not. I also goofed. +19
seagull  https://www.youtube.com/watch?v=Kps3VzbykFQ This video is a pretty decent explination worth your time on the subject. +2
hungrybox  I got it right but I was only like 50% sure. So I appreciate it. +
teepot123  ^ same video above used when I analysed my form 20 q which I got incorrect at time, its very clear at explaining this, helping me get it correct on this form +
... hayayah made a comment on nbme21/block3/q#27 (A 55-year-old woman with a benign nodule in the left...)
 +19 
submitted by hayayah(1056)
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The rhtoiyd si pldpiesu hwit riaatlre oobdl omfr teh euopsrir hdiyrto ,atyerr a hbracn fo het lerxaent rotdcai etyrar, nda eht ifonirer rydhtio rea,ryt a crnhba of the viyeaoctrchlr krnu.t

... beeip made a comment on nbme21/block4/q#6 (A 55-year-old man comes to the physician because of...)
 +19 
submitted by beeip(123)
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Tish sha enbe a othgu cntecop for em ot ,gte but I inthk Im' lnyalif :hteer

Teh etms is ceinsgirbd yrprima ernadal fciii,ncfnsyeu ro nsosAdid.'

  • HTCA si iengb pevcro-eoudrd to muslaitte the asedrlan ot opdcrue rios,oclt tub ehyt n'tca esdpor,n hreeit edu ot pyhtaor ro riesdttucno B(,T :mntuuoimea 4R,D tc).e
  • heT sftir 31 iamno dscai fo CAHT nac eb elvecda ot ofrm ,HฮฑM-S ichhw metistuals nsm,toeclyea giauncs ernaetphtmgipyoin
jotajota94  Good job! Also, cortisol is involved in maintaining blood pressure. which was decreased in the patient. +7
tinydoc  Decreased Na and increase K+ --- Hypoaldosteronisim Hypoglycemia, and hypotension --- Hypocortisolism so the adrenals arent working ---- adrenal Insufficiency the Hyperpigmentation comes from the increase ACTH as ACTH is from Proopiomelanocorticotropin. SO - increased ACTH also increases a -MSH ---> Hyper pigmentation. +10
hungrybox  thank u for this answer +
bilzcop  Ugh! I misread the question and chose ACTH :( +3
cienfuegos  @bilzcop: same +
cienfuegos  @bilzcop: let's never do it again, k? +1
maxillarythirdmolar  Why does this patient have elevated BUN and creatinine?? +2
lovebug  @ maxillaryhidmolar > I don't know exactly. but maybe.. Low hypo-adlo -> our body lose water -> hypo-volemia -> Decreased GFR -> Increased Cr,BUN. If I'm wrong. please correct me. +
... hungrybox made a comment on nbme21/block4/q#20 (A 7-month-old boy is brought to the physician 2 days...)
 +19 
submitted by hungrybox(968)
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sTih doive ipxnesla tilgnae myybolreog eertemxly lel.w

fI uoy felt lyatlto slot iekl ,me achwt hte devoi trifs at ,x2 nthe chkec tuo het obmott eiufrg on g.p 608 in FA .2019

veRetanl ot stih teu:soinq

  1. RYS sroinpte smeatuitl mldnetepvoe fo etsets
  2. ihTs pt hsa etsset g&;=t eh ustm ahve hte YRS egne no the Y sromcohmeo
  3. MIF esgrdead eht rlieuMlan ,dtuc chiwh would oiresthew cebmeo eht ilertnna emfael ieigtaanl
  4. This pt hsa learinnt elaefm itgenaial &t=;g nddi't kaem neohgu IFM

Qizu eslrufoy (rwasesn in a atrepeas s):tpo

  1. Tihs psant'tei iedrodsr cna eb ardcte kbac ot ihhwc lslc?e
  2. This taptnie had armlno ae.ltignai fI isht ttinpea dha msarell igelaiatn thna n,rmlao ttha odwul eb a eectfd ni atwh zmy?nee
ergogenic22  I like to work backwards. 1) patient has normal testicles on histology, normal appearing penis this must mean a Y chromosome is present, as testis determining factor is on the y chromosome (see above post point #2). I.e. you can eliminate choice A and B. Theoretically, 47XY and 47XYY could also present with female genitalia due to lack of MIF, but normal 46XY is more common +11
... cantaloupe5 made a comment on nbme21/block4/q#25 (An 80-year-old woman cannot concentrate her urine...)
 +19 
submitted by cantaloupe5(72)
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eShsโ€™ tigankni 540 Osmm rep ayd os ehs nesde to etexcre 450 msmO pre yad to aiatmnni bireq.luiuim uoY ctanโ€™ stuj ecreetx โ€™sOmms yb htselsemev -- yeht heva to be ivsleddso in osme oaumtn fo awert.

sLeโ€™t yas uoy ectreex 405 sOmm iwth 500 mL of tarwe -- hatt smane ouyr dyksine are niroeagtcnntc irune to:

045 msmO รท 005 Lm = 009 mOLms/

tBu teh umxammi shti daโ€™syl eyksind nca crttaeeoncn uerni ot is 450 /LmO,ms os hes sah ot erectex emor rwate ot egt it taht .iduetl tahT aotmnu fo rtawe is 1 L, auebsce 045 /Osmm1 L = 450 msmL/.O

wNo โ€™heters nhitong onsgptip her rmof egcnritex the 504 ssmmO in na eevn mroe iledut eniur -- for epalxem if hes kadnr an rxeta L fo rtawe noe ay,d eht yksdeni colud etg dir of ttha exrat L hiwt the easm ntouma of 540 sOmm by tluindgi the irune ot 450 msmO รท 2 L = 252 /mLsmO. But eht inesutoq skas orf eht mnmmiui mnaotu of aerwt -- ihcwh is 1 L yb eth sikeydn +( 1 L fmor eth oerht sftfu orf a tloat fo 2 .L)

... imgdoc made a comment on nbme21/block2/q#33 (A 68-year-old man comes to the physician because of...)
 +18 
submitted by imgdoc(132)
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I uhgotht tbaou it lkei i:sht Pttnaie si hvangi nsicepcgyho ED - ist lal ni sih deh,a lioidb si mlanor and altoucnrn rnetocsei era olnamr.

fI his steteoTrenos lleev aws low - ibdLoi es.eddecra fI shi vnueosr seytms tt(aphytspcamyc/pmatasiheie)r aws egdamad - runcolatn ctiseorne aeded.scre

eoHp tihs hleps.

sars  Idk about this. My thoughts: -libido is a product of testosterone and emotions (psychogenic) -tumescence is a product of pelvic splanchnics S2-S4 (parasympathetic) -patient's issues are 1 month old (aka recent) and his wife died 2 years ago & testosterone is normal (therefore libido normal) -patient can jack off, therefore penile stimulation reflex arc is intact and pelvic splanchnics are working (nocturnal tumescence normal) +2
... feronie made a comment on nbme21/block3/q#7 (A 65-year-old man comes to the physician because of...)
 +18 
submitted by feronie(18)
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hyritoccmeO = โ†“ eotstsreotne tupnodrico = โ†“ DTH tg&;= soeptrat lcesl geudorn sopoi.stap shT(i sinmaehcm si amsriil to uisng r5acseuฮฑtd-e oekslbcr to ertat B.)PH

ospsAiotp si acatehdrreczi by DNA rnfgmtnataieo ypos,ns(ki yreorhkiar,sx ora.s)skylyi

hungrybox  DNA fragmentation histopath: https://i.imgur.com/nxYW8vL.png Note that degradation in apoptosis is progressive. From pyknosis -> karyorrhexis -> karyolysis. Aka condensation -> fragmentation -> complete dissolution. +22
... hungrybox made a comment on nbme21/block3/q#20 (A 68-year-old woman has had a fever and shortness of...)
 +18 
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omes gornw erwnssa:

*kemas ssnee cb/ elomyatsslb are rsueosrrpc ot y,tsauercnolg iwhhc sue OMP to gthfi ffo eciitfnnso

temmy  Hungrybox aka life saver +1
hello  Thank you!!! +
bbr  ....uh yeah im pretty sure we just call em "Auer Rods" now. Appreciate the answer tho! +6
... cellgamesgojan made a comment on nbme21/block3/q#35 (A 63-year-old woman comes to the physician because...)
 +18 
submitted by cellgamesgojan(39)
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VA tsuaislF toe-rru loodb frmo the ielrarat sytmes to het nuesvo ,temssy anb-ssyigp the Ateelirosr = caeIsenr LP t-;&-g- ESACRNIE RV. llA in lal = reneasIc C.O

ocgcrdAni ot ,drUloW eht otaierlser are a omjar oecsru of eaiscsretn ... so snpabisgy eth iotrarlsee sruselt ni a deeecrsa ni otTal hrepaerilP sseateiRcn ... scunagi na ecsnirae in the raet and uvemlo fo doolb irnruengt to eht .haert I am tpyter ruse eerht is oerm to eth phigosoyly ehnbid sh,it ubt I oeph iths edxpalien a etllt.i

big92  "Immediately following creation, arteriovenous fistula (AVF) is associated with an increase in cardiac output (CO), achieved predominantly through a reduction in systemic vascular resistance, increased myocardial contractility, and an increase in stroke volume (SV) and heart rate. Over the following week, circulating blood volume increases in conjunction with increases in atrial and brain natriuretic peptides. These alterations are associated with early increases in left ventricular (LV) filling pressure with the potential for resultant impact on atrial and ventricular chamber dimensions and function." (PMID: 25258554) There's also another study by Epstein from the 1950s looking at the effects of AVF's effect on CO in men (PMID: 13052718). Apparently, the increase in resting CO is a big problem because it can lead to high-output cardiac failure (LVH). +23
hungrybox  Jesus big92 you went in on the research lmao u must be MSTP +6
temmy  big92 you are right. that is why pagets disease pagets have high output cardiac failure because of the av shunts. +4
kevin  what is "increase PL" +2
... hayayah made a comment on nbme21/block4/q#23 (An investigator is studying the regulation of...)
 +18 
submitted by hayayah(1056)
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pmhLy lwfo raet si alluyus .lwo tI si dnunlifeec ymaiirprl by eht rate fo hlpym iraoofmnt. roF el,mpeax fi loodb palrlayci seprsrue si eaneicsdr by eralirta snatilvoiaod or venosu itorstncocin, eht ofwl aetr fo ylphm nceie.ssar s,olA hte flwo arte si fftdaece yb opcsneosimr of cipyhlsatm yb nricootnact of bgioinrnheg cmlreausutu adn yb egenvtai iarctcoitrhna rpsereus tinr.b(a)heg

Iaitilntrste rupreess o(s rsuesrpe in het E,CF icwhh wuold ceranise fi gnvie IV elans)i and pmhyl lowf are ovytiilspe eate.ldr A llsam seacirne ni stitantiirle mvueol yeglart ecaienssr ist sererpus, gnopitomr ypmhl lwof hatt stca ot oertrse teh slittenairit vlmueo to nmrl.oa

rmeo no siht ti:poc v.s.Kib/itsp4.5B/8wnwo3.Nhk:b/4o/o/wnclmgthn

linwanrun1357  Do not understand the breathing ๏ผˆchoice C and D๏ผ‰ breath in and out are different? +
khanhluong  I don't know if it's correct or not but how I approached C & D was that they both cause vasoconstriction in the arterioles (because this is the lung where hypoxia causes vasoconstriction), which decreases hydrostatic pressure through the capillaries and eventually decreases lymph flow. Maybe I completely got this question right for wrong reason, but I felt that it works with all of the answers. For F) I was thinking that it would cause increased capillary oncotic pressure which causes more fluid to go into the capillary than into the lymph vessels... Here's a picture: http://www.lymphedemablog.com/wp-content/uploads/2011/09/Lymphatics.gif +5
... seagull made a comment on nbme21/block4/q#40 (A study is conducted to assess the normal mean serum...)
 +18 
submitted by seagull(1404)
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agmnEinxi peiattn rmfo a gtsoiorlu isempli nkrseBo iBas icwhh udlwo wsek hte pnuialpoto enam of resum aeur ogennitr yaaw rfmo eth uret cractaue .nmae ,neTh elierza iencosirp is etpdneend on alsstiticat e"rPwo" hhiwc is ierdcsnea asebd no het zesi fo eth tlunioopap fo eht tuysd. era(decsin cpnoresii = eirdnceas tsctaaiitls o.)wrpe ehreTor,ef an aciernes in uiotlpnopa of a aebsdi upogr wthi aeld to yiarcuncac iwht ghih in.soierpc

forerofore  to add up, the urologist himself doesn't add or remove accuracy (since this is a blood test), what decreases the accuracy is the fact that in order to be sent to a urologist you probably are sick in the first place (selection bias), so your urea nitrogen is likely to be altered. +21
sharpscontainer  I thought of precision as more of a function of variance. Variance will decrease with a greater sample size. Had a hard time because I was thinking about those 4 darn targets (wouldn't 500 darts look more spread out than 10? but no, the variance will be better) that have been in my textbooks since 7th grade and for the first time I was asked a question about this concept only to discover that I didn't have it down as well as I assumed. +1
peridot  @sharpscontainer I feel you, I thought the exact same thing. Looked into it a bit and I think it has something to do with the way standard error or standard deviation or something like that is calculated, but I'm still confused and too tired to dig further. Also, wanted to mention that this NBME has a similar question but instead it's about the 95% confidence interval - maybe that'll help you understand the precision thing better since the 95% confidence interval narrows with a larger sample size? So it's kinda tied to precision? +
... drmantistoboggan4 made a comment on nbme21/block1/q#47 (A 26-year-old woman (III-2) comes to the physician...)
 +17 
submitted by drmantistoboggan4(17)
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It isad it saw ltafa ot salem ni et,uor adn het untieqso ksade obaut lvei ronb op.nfrgisf Seicn het maesl โ€™rtaen gnbei bonr ni eht tfrsi ,celpa I dsia 5%0 emfslae dna %0 ae.lms

hungrybox  fuck i got baited +30
jcrll  "live-born offspring" โ† baited +21
sympathetikey  Same :/ +
arkmoses  smh +
niboonsh  why is it 50% females tho? +2
imgdoc  felt like an idiot after i figured out why i got this wrong. +1
temmy  oh shit! +
suckitnbme  This isn't exactly right as males can still be born as evidenced by individuals III 6,9,11. This basically an x-linked recessive disease. A carrier mother can still pass her normal X chromosome to a son (50% chance). It's just that the other 50% chance of passing an affected X chromosome results in death of the fetus in utero. Thus all males actually born will not be affected. +2
makinallkindzofgainz  @suckitnbme, Correct, but if you're a live-born male, you 100% for sure do NOT have the disease, so the chance of a live-born male "being affected" is 0. +3
spow  @suckitnbme it's not X-linked recessive, otherwise every single son would be affected and therefore have died in utero. It's X-linked dominant +2
qball  Jail-baited +
... ergogenic22 made a comment on nbme21/block1/q#6 (A normal-appearing 17-year-old girl has never had a...)
 +16 
submitted by ergogenic22(301)
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minochtra viegtnae = on rbra eibdos = oerpsn iwth YX eptegnoy ro OX sbceuea myateni ouy ehva mroe hatn noe X oohmcrosme yuo veha a rabr body ciamn(hrot )epitoisv

... hayayah made a comment on nbme21/block1/q#11 (A 27-year-old primigravid woman at 34 weeks'...)
 +16 
submitted by hayayah(1056)
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PELLH dore:ynms viayel HsstEmedel o Liver nowezsym Le eeatsllP.t

A inoanmaeitfts fo vresee laisrmeeacp.p lBodo earsm hsswo otissccyh.ets aCn alde ot DIC adn phcieta hmarlomcputsbs ausaea ยŽ etrpuru ยŽ eeervs npyo.hionste

mambaforstep  FA 2019 pg 629 +2
qball  One thing I find odd with this question is HELLP is a manifestation of severe preeclampsia but she has had an otherwise unremarkable pregnancy. Shouldn't she have hypertension/edema in regards to her pregnancy beforehand? +
demihesmisome  Pre-eclampsia, if not severe, can be entirely asymptomatic. +1
misterdoctor69  Her blood pressure is 164/102, which qualifies her as having preeclampsia. +
... step1soon made a comment on nbme21/block1/q#16 (A 43-year-old man comes to the physician for a...)
 +16 
submitted by step1soon(45)
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aelmesoddkteahoisvi/rar/c-voatyu:pg.h/lrsy-/late

ooLk ta hreew hte uspcs are iotnpgni โ†’ srpdwua retfohree .oicrta if pcsus erwe norwadwd โ†’ hnte iarltm lvave duolw eb teh griht awesnr

misterdoctor69  mitral valve would only have 2 cusps even if it were replaced though right?... +
bbr  After staring at this for awhile, I wanted to elaborate on this to make it even clearer. The 3 areas that meet at a point would be the 3 cusps. These 3 flaps are going to get blown open. Means flow is from down to up. +3
... nicnac20 made a comment on nbme21/block1/q#28 (A 47-year-old man is brought to the emergency...)
 +16 
submitted by nicnac20(18)
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dxieM unsvoe gyxeno eiosntn is the oatnmu fo noygex dounb to nligomeobh sa it rsrtenu ot eht htirg eisd fo eth harte rtefa vgelntria to het s.sitesu

ecDerasde nyeoxg verdylie ot eht essiuts ude to scedaeerd rcicaad tutpou slade to teh sesusti ctiaegxrtn emro xonyge rmof eht ipgassn BRsC ahtn ythe mylrnalo l,dwuo chwhi ascesrdee hte eorlval emdxi vsunoe xoygne o.tiesnn

pparalpha  A helpful equation is CO=rate of O2 consumption/(arterial O2 content-venous O2 content): Fick principle If CO is decreased, then the difference between arterial O2 content and venous O2 content is increased +15
misterdoctor69  To clarify a little bit, the tissues wouldn't necessarily extract MORE oxygen from the passing RBCs than they normally would. They would extract the same amount as they normally would to carry out their own functions. However, because the starting amount of O2 delivered to tissues is lower, you'd end up with less O2 bound to hemoglobin returning to the right heart. +5
... hayayah made a comment on nbme21/block2/q#29 (A healthy 25-year-old man is participating in a...)
 +16 
submitted by hayayah(1056)
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.P 91 of AF ahs a ucqik xontnilaaep rof tsih!

ysaacllBi neoc 'reoyu ni a gartsvni tatse thres'e tlsil theacip cognsoeuesiglen nggio no (sa lwel as nsugi A)FF but hte leooenueissgcng is gcimno mofr rpeehrialp sieust tatecal and ila.nane

... dr_jan_itor made a comment on nbme21/block2/q#34 (A 28-year-old man is brought to the emergency...)
 +16 
submitted by dr_jan_itor(70)
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otOipn A si eth ynol pnitoo ewreh btho mslcseu era prta fo het rliobat .flo Aro,los eth slta cneneets in the iuosntqe smte si a oatlt ofiderym fo twah noe oludw txepce hte inoeqsut ot eb ksn.aig It is ton kisang rof ouy ot amsesu ttha eehst sescuml evah eneb versee,d aezlap,dyr or erderend .dailcf It is angsik yuo ot uamses hatt eyht haev ebmcoe npepdert"a" if teh ulcmse si dpeea,tnrp tnhe it antcno alolw eht eye ot ovme inot ewrthave isioptno ti lwduo be ni when teh csumel si ta sti deelntngeh i.isnotpo So ni shti ,aces It si eth irifnore urcets ignbe ppeentrda ni a uloiflnantcy ethronesd potosini that is vrnptegnei wradpu eg.az

nutmeg_liver  @cjdinurdreamz it does make your eye look down, so since it's trapped in a functionally shorter position you're trapped looking down, not up. +2
... beeip made a comment on nbme21/block4/q#34 (A healthy 8-year-old boy is brought to the physician...)
 +16 
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tiayctr"oEx nomai s"dcia rfeers ot gltem,utaa wileh oi"c"eigBn rleyapapnt refsre to ire,ytson eht rpuosrecr AA ot pmoeadni nda enr.opi

sahusema  Amphetamines use the NE transporter (NET) to enter the presynaptic terminal, where they utilize the vesicular monoamine transporter (VMAT) to enter neurosecretory vesicles. This displaces NE from the vesicles. Once NE reaches a concentration threshold within the presynaptic terminal, the action of NET is reversed, and NE is expelled into the synaptic cleft +9
mumenrider4ever  FA 2020 pg. 239 +3
... nosancuck made a comment on nbme21/block1/q#17 (A 7-year-old girl is brought to a clinic in a...)
 +15 
submitted by nosancuck(85)
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Yo awdg ew lla abuot TVP ITM HaLL

nnyllieanP,ahe li,nVea ApKTtNoryD, e,rnonhTie ,soencieuIl tniienhoe,M ,ineiHtdis inuLcee nyeLsi

meningitis  I don't understand what the question is asking... can someone please explain it to me? Patient doesnt eat protein, shes chubby. What does methionine have to do with this? +2
charcot_bouchard  Just basically asking which is essential amino acids. +3
usmleuser007  Essential amino acids (something i came up with) 1. "Three HAL fans will try meth" a. Threonine = Three b. Histidine; Arginine; Lysine = HAL c. Phenylalanine = fans d. Valine; Isoleucine; Leucine = will e. Tryptophan = try f. Methionine = meth +3
nala_ula  They're saying there is a lack of good quality protein -> slight nutritional deficiency. She may have acquired weight but it's not because of protein. So they're specifically asking what amino acid she might be missing due to her subpar diet. Since essential amino acids are those that the body cannot make itself, out off those listed, methionine is the essential amino acid. It's on page 81 of FA 2019. +9
nala_ula  correct me if I'm wrong please :) +
hello  For anyone confused trying to follow @usmleuser007's comment -- slightly modified Essential amino acids mnemonic "Ah, Three fans will try meth" Ah = arginine, histidine Three = Threonine Fans (phans)= Phenylalanine Vil (Will -- German accent pronouncing English word 'will') = valine, isoleucine, leucine, lysine Try = tryptophan Meth = Methionine +1
pg32  Why does @hello and @usmleuser007 mnemonic contain arginine? That isn't in the PVT TIM HaLL mnemonic for essential amino acids... +
paperbackwriter  @pg32 arginine is semi-essential. It is essential in preterm infants who cannot synthesize it https://www.sciencedirect.com/science/article/pii/S0955286304000701?via%3Dihub +